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General NPI Number Information
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NPI Number | 1871006734
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Entity Type | Organization
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Legal Business Name | PARKSIDE ASSISTED LIVING AND MEMORY COTTAGE
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 2595 HARBOR BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6724
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Country | US
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Telephone | 941-766-7444
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Fax | 941-979-5884
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Provider Business Mailing Address
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Address Line | PO BOX 496420
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-6420
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Country | US
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Telephone | 941-629-2111
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Fax | 941-627-5377
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAKINA KHALIDI
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Credential | MD
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Telephone | 941-629-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL13075
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License Number State | FL
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